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Fred Rezvani
Specialist in Ridgewood, New Jersey
NPI 1104887694

Fred Rezvani is a Specialist based in Ridgewood, NJ. Fred Rezvani practices in Ridgewood, NJ. The NPI Number for Fred Rezvani is 1104887694 and holds a License No. 25MA05115800 (New Jersey).

The current practice location address for Fred Rezvani is 119 Prospect St, Ridgewood, NJ and can be reached out via phone at 201-444-1600 and via fax at 201-444-8774.

Location: 119 Prospect St, Ridgewood, NJ, 07450-4405
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1104887694
Provider Name
Fred Rezvani
Credential
Provider Entity Type
Individual
Gender
Male
Address
119 Prospect St, Ridgewood, NJ, 07450-4405
Phone Number
201-444-1600
Fax Number
201-444-8774
Provider Enumeration Date
04/01/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0028398 01 NJ AETNA HMO #
0562861001 01 NJ AMERIHEALTH #
0K6927 01 NJ HEALTHNET #
30G161 01 NJ EMPIRE BC/BS OF NY
4226530 01 NJ AETNA PPO #
BP204 01 NJ OXFORD ID#
institution
Provider Business Practice Location Address Details
Address
119 Prospect St
City
Ridgewood
State
New Jersey
Zip
07450-4405
Phone Number
201-444-1600
Fax Number
201-444-8774
person
Provider Business Mailing Address Details
Address
119 Prospect St
City
Ridgewood
State
New Jersey
Zip
07450-4405
Phone Number
201-444-1600
Fax Number
201-444-8774
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
25MA05115800 (New Jersey)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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